Localized ulceration may be reached through the kaleidoscope or proctorial, treated with pure tincture of iodine and dusted over with some antiseptic powder. The diet should consist largely of nitrogenous foods with a moderate restriction rather than absolute abstinence from the carbohydrates and fats.

Ipecac has been used for the treatment of amebic dysentery for some time with variable success, dependent probably upon the manner of administration and the control of the patient. Thirty grains of ipecac are recommended at a single dose on the first day of treatment, after the method of Manson in chronic amebic dysentery. Subsequently, the amount is to be diminished by five grains each day so that by the sixth day only five grains of the drug are administered. During the next succeeding week or ten days, five grains each night should be given. When the ipecac is administered in the salon coated pills, vomiting is infrequent, and the drug has the added advantage of being dissolved by the alkaline secretions of the intestine only. It is advisable to have the patient fast for about four hours previous to the administration of the ipecac and to be absolutely quiet for the same period afterward

Chamberlain in the Journal of the American Medical Association, April 6, 1912, is quoted as follows as to the "Experiments Undertaken to Test the Efficiency of the Ipecac-Treatment of Dysentery." "So far as known, the first attempt to determine the value of the ipecac treatment of dysentery by laboratory methods has been made by a member of this board (Redder). In these experiments cultures of am-bas from a human stool were treated with preparations of ipecac from various sources and from different dilutions.

As a result it was determined that fluid-extract of ipecac was capable of killing amoebas in dilutions of 1 to 10,000 up to 1 to 50,000, the bactericidal power depending on the particular extract used, and that emetic killed amoebas in dilutions of 1 to 100.000. The commercial extracts of ipecac were further shown to vary considerably in total alkaloids, some being below the standard of the Pharmacopeia and some slightly above. The conclusion was reached that the ipecac treatment of dysentery should be given a more extended trial, that before treatment great care should be taken to be sure that the dysentery was caused by amoebas and that an ipecac should be used which is shown by actual analysis to contain the proper amount of emetic"

Of further interest he adds: "Effects of Ultraviolet Rays on Amoebas: In view of the recently reported successes on the use of ultraviolet radiations in the sterilization of drinking-water the board carried out a series of experiments to determine the effects of these rays on amoebas (Chamberlain & Redder). It was found that the ultraviolet radiations would kill amoebas, whether motile or encysted, as rapidly as they would kill bacillus typhus or bacillus dysentery Ba l-antidia were also readily killed. The results are of much practical importance in the sterilization of water supplies in the tropics because sand-filters cannot be relied upon to remove amoebas"

Bacillary Dysentery. This infection is due to the bacillus dysentery, (Shiva bacillus), or one of its protean types. The bacillus is described by Shiva as a short rod with rounded ends, which resembling the bacillus typhoons and the group of colonic bacilli. No theory as to how the germ enters the human body has proven satisfactory.

Symptoms. The disease is generally ushered in with a chill, rise of temperature, abdominal pain, tenements and heat or burning in the rectum. The movements at first are watery and afterward become entirely of a bloody character. Sometimes there is nausea, prostration, with collapse in severe cases. In the protracted cases emaciation is very progressive. Investigations have shown that the lesions are superficial in character, more commonly found in the lower end of the colon or sigmoid and that the peritoneum is rarely affected. Death is due to the action of the toxins generated by the bacilli.

Diagnosis. The bacillus dysentery is found in large numbers in the stools and the scrapings from the intestinal wall and are not demonstrable in the outer layers of the gut. Stricture is very apt to occur as the result of these ulcerations, as they have a marked tendency to fibrous contraction when healing. A positive agglutination is revealed in the blood.

Treatment. The bowels should be flushed out by the administration of calorie, magnesium sulphate or castor oil, and the colon irrigated every four or five hours. Normal saline and sulphate of quinine in one to one thousand solution are the irrigation most commonly used. Ipecac as recommended in amebic dysentery is also used for this disease. Sedatives in the form of opium to control pain and diarrhea should be administered in conjunction with tonic treatment. Serum therapy is just venturing into the field of the treatment of these dysentery diseases and it is hoped that within the near future it may prove of value. The diet should be sufficient to maintain the strength of the patient and consist of nitrogenous foods, rice, milk and animal broths.

Catarrh Dysentery.

This disease is due to a mixed infection by bacilli commonly found in the intestinal tract and its infectious character is still a question of doubt. No specific organisms have as yet been isolated which might be considered responsible for the disease and until a certain etiological factor is discovered the disease had better be classified as a catarrh inflammation.

Syphilitic Diseases of the rectum and colon are in the form of local manifestations. The symptoms, diagnosis and treatment are considered under the various phases presented in the text elsewhere.

Gonorrheal Proctorial is described under the chapter on venereal diseases.

Erysipelas Proctorial has always proved fatal according to the few cases recorded. The disease seems to have been observed only in hospital practice.